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APPLICATION FOR FINANCING
Date of Birth
Language of correspondence
Date of establishment or incorporation
Date of commencement of commercial operations
# of months in activity a year
Months in activity
Business Partners, Officers and/or Company Shareholders
Date Of Birth
Youth Strategy Fund
Economic Development Fund
The Applicant/Guarantor hereby applies to the corporation Pontiac Community Futures Development Corporation (SADC) for financing of $.
The following project to be financed:
The total cost of the project is
Sources of financing
This project is expected to keep:
This project is expected to create:
The business managers and/or owners are:
Is the Applicant and if applicable, the Guarantor(s) engaged in operations and processes that require:
a) Disposal and/or treatment (either onsite or offsite) of industrial wastes or by-products that could contaminate the soil or groundwater (e.g. hydrocarbon/water mixtures and emulsions, solid, liquid or gaseous chemical products, organic solvents or wastes, organic wood-preserving chemicals, infectious waste, radioactive waste, PCBs, etc.)?
b) Discharge wastewater that contains such wastes or by-products into water bodies or into a sewerage system?
3. Declarations: The Applicant and if applicable, the guarantor(s) must read each statement and insert their initials in the box to the right. For any untrue statement(s), enter details in the space provided at the end of this paragraph. The SADC will deem a statement to be true unless details to the contrary are provided.
a) Interested Persons: None of the Applicant/Guarantor, the partners of the Applicant firm / Guarantor firm or the shareholders, directors or officers of the Applicant/Guarantor, if incorporated, is an “interested person”, meaning: (i) a director or officer of the SADC; (ii) the spouse or common-law partner or a child, brother, sister or parent of a director of the SADC; (iii) the spouse or common-law partner of a child, brother, sister or parent of a director of the SADC; or (iv) the father, mother, sister or brother of the spouse or common-law partner of a director of the SADC.
b) Dealings with the SADC: None of the Applicant/Guarantor, the partners of the Applicant firm / Guarantor firm or the shareholders, directors or officers, if incorporated, has been a borrower or guarantor or a director, officer or shareholder of a corporate borrower or guarantor of a loan from the SADC.
c) Immigration status: The Applicant/Guarantor (and their shareholder(s) if incorporated), are Canadian citizens or permanent residents of Canada.
d) Financial Statements: There has been no material worsening in the financial position or operations of the Applicant/Guarantor since end date of the last fiscal year of the Applicant for which a balance sheet and income statement have been provided
Name and address of Applicant's/Guarantor’s external accredited accountant
e) Legal Problems: There is no litigation, legal action, suit or claim pending, underway or looming, nor any proceedings before any court, tribunal, government board or agency now underway or looming, and there is no unexecuted judgment rendered against the Applicant/Guarantor.
f) Material Contracts: The Applicant/Guarantor is not in default under any material contracts to which it is a party or that affect the Applicant’s/Guarantor’s business or assets.
g) Bankruptcy/Insolvency: The Applicant/Guarantor (and their directors and officers, if incorporated), have not been declared bankrupt under bankruptcy proceedings (discharged or not) and have not been the subject of other insolvency proceedings or proposals.
i) Criminal Record (all types of offences): None of the Applicant/Guarantor (and their directors and officers, if incorporated), have been convicted of an offence (you may exclude a conviction for which a pardon has been granted).
j) Permits / Licenses: The Applicant/Guarantor holds all the permits and licenses required by law for its activities, including if applicable, those related to the proposed project
Declaration – Comments by Applicant and Guarantor(s) regarding exceptions to the above statements (attach and initial additional page, if needed.
4. The Applicant and if applicable, the guarantor(s), certify that the information reported in this document is true, accurate and complete, and acknowledges that the SADC will be relying on the information in considering this and future applications for financing. If untrue, inaccurate or incomplete information is provided, the SADC may, at its sole discretion, decline a loan application or, if a loan has already been granted, may cease disbursement of funds and demand the full repayment of loan proceeds already disbursed.
5. The information and declarations under this application are to remain accurate and in force. The Applicant and if applicable, the guarantor(s), shall ensure that the declarations set forth herein remain accurate and up to date at all times and shall immediately notify the SADC if any of them are no longer accurate.
7. This form may be executed and delivered by original signature or by a true image of the signed original delivered by fax or by electronic means. The SADC will be relying on and acting on the information, representations and statements contained in the imaged copy to the same extent as if it was bearing an original signature.
8. Consents to Inquiry: Individuals having an interest in the loan will be asked by the SADC to provide a piece of photo identification (e.g. passport; driver’s license). The SADC will make and retain a copy for its files, for the purpose of verifying the identities of parties it is dealing with, to comply with anti-fraud procedures and laws and to reduce the chance of making errors when preparing and registering security documents in relation to the loan.
The Applicant and if applicable, the guarantor(s), consent to the SADC making any inquiries, including obtaining personal, corporate and business information about them (and their directors and officers, if incorporated, with the corporation declaring it has the authority to provide such consent on their behalf) from such persons, firms, corporations, government authorities, institutions or agencies as it deems necessary in order to reach a decision on any application and to administer an eventual loan, if such is the case. The undersigned consent to the SADC exchanging information with other financial institutions or financial partners regarding any project under consideration. While the Applicant and if applicable, the guarantor(s), are not required by law to consent to such inquiries and to such information being obtained, their refusal to consent may prevent the SADC from considering an application for financing.
Pursuant to the provisions of the Privacy Act, subject to certain exceptions, the Applicant and if applicable, the guarantor(s) (and their directors and officers, if incorporated), have the right of access to, and protection of, personal information that may be obtained by the SADC.